Factors associated with non‐nutritive sucking habits at 2 years of age among very preterm children: EPIPAGE‐2 cohort study

Abstract

Background The association between prolonged non‐nutritive sucking habits (NNSHs, ie, sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described. Because maturation of sucking abilities is not fully achieved in very preterm infants (<32 weeks’ gestation), neonatal services worldwide rely on the use of pacifiers to promote the development of adequate sucking reflexes, possibly prolonging NNSHs during infancy. Objective We aimed to describe the frequency and to identify factors associated with NNSHs at age 2 years in very preterm children. Methods The study was based on data from EPIPAGE‐2, a French national prospective cohort study of preterm births during 2011 that included 2593 children born between 24 and 31 weeks’ gestation. The primary outcome was NNSHs at 2 years. Multivariable log‐linear regression models with generalized estimation equations were used to study the association between the characteristics studied and NNSHs. Multiple imputations were used to take into account missing data. Results The frequency of NNSHs was 69% in the overall sample but higher among girls (adjusted risk ratio [RR] 1.12, 95% confidence interval [CI] 1.05, 1.17), children born from multiple pregnancies (eg, twins/triplets) (RR 1.07, 95% CI 1.00, 1.11), children who were fed by nasogastric tube (RR 1.07, 95% CI 1.01, 1.13), or those who benefitted from developmental care programmes (RR 1.10, 95% CI 1.02, 1.19). The NNSHs frequency was lower if mothers were not born in France (RR 0.70, 95% CI 0.64, 0.77), children had 2 or more older siblings (RR 0.88, 95% CI 0.82, 0.96), or children were breast‐fed at discharge (RR 0.90, 95% CI 0.85, 0.95). Conclusions NNSHs at 2 years seemed associated with cultural background, development care programmes, and breast feeding. Whether NNSHs at 2 years among very preterm children are associated with future maxillofacial growth anomalies deserves further attention.

Risk Factors for High-Arched Palate and Posterior Crossbite at the Age of 5 in Children Born Very Preterm: EPIPAGE-2 Cohort Study

“…Pacifier sucking is common and even recommended in infants born very preterm during neonatal hospitalization to support maturation of oro-facial motor function and to minimize pain (18)(19)(20). The frequency of NNSHs during infancy seems higher in infants born preterm than those born full-term (21).…”

“…Breastfeeding was associated with less NNSHs in children born very preterm (21). The recent studies of preterm children and the general population in Brazil concluded shorter duration of breastfeeding associated with increased risk of malocclusions (including posterior crossbite) at the age of 5 (25,49).…”

“…The evidence suggests that at least 2 years of pacifier use are necessary for substantial alteration in palate morphology (47). Preterm children seem more likely to have NNSHs than full-term children (69 vs. 51% at the age of 2) (16,21).…”